Financial Clearance Specialist IV - Admitting - Full Time 8 Hour Variable Shift (Non Union)

University of Southern California•Glendale, CA

1d•Onsite

About The Position

The Financial Clearance Specialist IV is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete. Documentation of accurate insurance information, knowledge of insurance plans and authorization details to optimize reimbursement from the payer are required. The Financial Specialist IV is responsible for extended understanding of division of financial responsibility to accurately adjudicate Letters of agreement to help streamline the claim management process. By securing the mutually signed Letter of agreement provides legal document that outlines the intent of both parties and will provide the supporting documentation needed for appeals for all non-contracted payers for both Professional and Hospital services. The Specialist IV must maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Specialist IV must also determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Specialist IV are to conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient’s representative. Specialist IV must maintain compliance with HIPAA regulations as it pertains to the insurance processes. Specialist IV must maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Financial Clearance Specialist IV must be proficient in hospital and professional contracted versus non-contract payers including interpretation of language specific to covered services. The specialist must also have an extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.

Requirements

Minimum (3) years of experience in a hospital, health plan or Physician office environment.
Extensive knowledge of contracted and non-contracted payers.
Extensive knowledge of division of financial responsibility.
Ability to articulate benefit negotiations when adjudicating a letter of agreement with a non-contracted payer.
Proficient in submission of authorization for all service types rendered within a hospital and/or professional setting.
Knowledge of business office procedures.
Knowledge of medical terminology and coding.
Knowledge of grammar, spelling, and punctuation to type patient information.
Extended understanding of payer DOFR and authorization submission for all service scopes performed in both a hospital and professional setting.
Ability to read, understand, and follow oral, and written instructions.
Ability to establish and maintain effective working relationships with patients, employees, and the public.
Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.
Capable of working assigned shifts, overtime when approved.
Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.

Responsibilities

Ensuring insurance eligibility, benefit verification, and authorization processes are complete.
Documenting accurate insurance information.
Optimizing reimbursement from the payer through knowledge of insurance plans and authorization details.
Adjudicating Letters of Agreement to streamline claim management.
Determining, communicating, and collecting patient liability prior to service.
Attempting to collect prior balances.
Conducting all transactions appropriately and consistently.
Completing Medicare Secondary Questionnaire accurately.
Maintaining compliance with HIPAA regulations.
Maintaining professional development by attending workshops, in-services, and webinars.
Verifying insurance and understanding CPT codes and medical terminology.
Interpreting patient liability and benefits for HMOs and all payer types.
Interpreting and completing insurance verification process for all types of payers including HMO’s Commercial, Medi Cal and Senior Plans, Medi Cal, Medicare, PPO, POS, EPO, Capitation, Military, Workman Compensation.